Little Ears and Little Voices: Speech and Hearing Care for Preemies

First published May 2018
Updated July 2026

Early identification and treatment of speech and hearing disorders is critically important for all infants and children. One population that requires extra care and attention are infants who are treated in neonatal intensive care units (NICUs). To develop speech and language appropriately, a child needs to hear approximately 45 million words by the age of 4.

For the tiniest patients, several days, weeks, or months may be spent in the hospital or NICU. Just because a child is in the hospital does not mean that hearing and listening aren’t important. Audiologists and speech pathologists work together to make sure that a child has exposure to language while admitted, which can lead toward better outcomes once the child comes home from the NICU.

Having a baby in the NICU can feel overwhelming. Many families are surprised to learn that audiologists and speech-language pathologists (SLPs) are an important part of the NICU care team. Audiologists are professionals that diagnose and treat hearing loss. Speech-language pathologists are professionals who diagnose and treat speech-language, voice and swallowing disorders. These professionals may be active members of the multidisciplinary team of medical staff that care for infants in the NICU.

What Does an Audiologist Do?

Approximately 2–3 out of every 1,000 babies are born with some degree of permanent hearing loss each year, making hearing loss one of the most common congenital conditions in newborns. Infants who require NICU care are at an even greater risk of being born with or developing permanent hearing loss due to factors such as prematurity, low birth weight, certain medications, infections, and other complex medical conditions.

To identify hearing loss as early as possible, all babies born in the United States undergo a hearing screening before discharge from the hospital through the Universal Newborn Hearing Screening (UNHS) program. Early identification is critical because hearing plays a vital role in speech, language, cognitive, and social-emotional development during the first months and years of life.

Audiologists are healthcare professionals who specialize in the prevention, identification, diagnosis, and management of hearing and balance disorders. In the NICU, audiologists play a critical role in monitoring high-risk infants and ensuring that hearing concerns are identified and addressed as early as possible. Because NICU infants are at an increased risk for hearing loss, audiologists work closely with the medical team to determine when babies are medically stable and ready to complete their hearing screening.

If a baby does not pass the newborn hearing screening, the audiologist performs a more comprehensive diagnostic evaluation called an Auditory Brainstem Response (ABR) test. This specialized test measures how the hearing nerve and brainstem respond to sound and can provide detailed information about a baby's hearing status, even while the infant is resting or sleeping.

When diagnostic testing confirms permanent hearing loss, the audiologist collaborates with physicians, nurses, therapists, and family members to develop an individualized care plan. This may include selecting and fitting appropriate amplification devices, such as hearing aids, while the infant is still in the NICU. Early access to sound is essential, as it allows children to hear speech and environmental sounds during a critical period of brain development.

Without appropriately-fitted amplification and timely intervention, children with hearing loss may experience delays in speech, language, learning, and communication development. By identifying hearing loss early and providing prompt intervention, audiologists help ensure that infants have the best possible opportunity to develop communication skills and reach their full potential.

What does a Speech-Language Pathologist (SLP) do?

While speech-language pathologists help children develop communication skills, they also have specialized training in infant feeding and swallowing.

SLPs work closely with families and the medical team to support your baby's feeding, communication, and developmental needs. SLPs foster early communication and development through support of caregiver interaction, helping families recognize and respond to their baby’s cues, monitoring speech, language and developmental milestones and providing recommendations for developmental activities.

For infants and children with hearing loss, SLPs, will closely work with families to monitor speech and language development and support children and families in developing communication skills, including speech sound development, understanding language, following directions, and play skills.

Some babies will have specialized communication needs. For this population, SLPs may support communication development for children with tracheostomy tubes, including the use of speaking valves when appropriate and help families learn strategies to encourage interaction and communication during everyday activities.

Why Is Early Intervention Important?

Whether your baby's NICU stay is short or long, early evaluation and intervention can make a meaningful difference. Connecting families with speech, language, feeding, and hearing services early helps support developmental progress and may improve long-term outcomes. Early support gives children the best opportunity to develop communication skills alongside their peers.

If you have questions about childhood speech/language and hearing disorders, contact Nationwide Children’s Hospital Clinical Therapies.